• Annals of surgery · Mar 2014

    The detection of intraoperative bacterial translocation in the mesenteric lymph nodes is useful in predicting patients at high risk for postoperative infectious complications after esophagectomy.

    • Eiji Nishigaki, Tetsuya Abe, Yukihiro Yokoyama, Masahide Fukaya, Takashi Asahara, Koji Nomoto, and Masato Nagino.
    • *Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; and †Yakult Central Institute for Microbiological Research, Tokyo, Japan.
    • Ann. Surg.. 2014 Mar 1;259(3):477-84.

    ObjectiveTo investigate the incidence of BT in the mesenteric lymph node and bacteremia after an esophagectomy using a bacterium-specific ribosomal RNA-targeted reverse-transcriptase quantitative polymerase chain reaction (RT-qPCR).BackgroundThere is little evidence regarding the occurrence of bacterial translocation (BT) and its correlation to postoperative infectious complications after an esophagectomy.MethodsEighteen patients with esophageal cancer were studied. Mesenteric lymph nodes were harvested from the jejunal mesentery before surgical mobilization (MLN-1) and after the restoration of bowel continuity (MLN-2). Blood and sputum were also sampled before surgery (Blood-1 and Sputum-1) and on postoperative day 1 (Blood-2 and Sputum-2).ResultsThe detection rates of bacteria in the MLN-2 (56%) and Blood-2 (56%) were significantly higher than those in the MLN-1 (17%) and Blood-1 (22%), indicating that surgical stress induces BT. The detection rate was not different between Sputum-1 (80%) and Sputum-2 (78%). There was an 80% sequence homology between the RT-qPCR products in the MLN-2 and Blood-2, whereas the homology was only 20% between Blood-2 and Sputum-2. In the patients with positive bacteria in the MLN-2 sample, there was a greater incidence of postoperative infectious complications than in patients without bacteria in the MLN-2 sample (P = 0.04). The postoperative hospital stay was also longer (P = 0.037) for patients with positive bacteria in the MLN-2 sample.ConclusionsBT frequently occurs during esophagectomies, and postoperative bacteremia is likely to be gut-derived. Patients with positive bacteria in the MLN-2 sample should be carefully managed because these patients are more susceptible to postoperative infectious complications.

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